Haryana

Karnal

551/2012

Rajiv Gupta S/o Ved Parkash - Complainant(s)

Versus

United India Insurance Company Ltd., United India Insurance Company Ltd - Opp.Party(s)

Vishal Goel

25 Nov 2014

ORDER

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL  FORUM KARNAL.

 

                                                          Complaint No.551 of 2012

                                                          Date of instt.21.11.2012

                                                          Date of decision: .17.03.2015

 

Rajiv Gupta son of Sh.Ved Parkash r/o house No.75/3, near SBI Shakti Colony, Mall Road, Karnal.

                                                                  ……..Complainant.

                   Vs.

 

1.United India Insurance Co.Ltd. near Bus stand, GT Road, Karnal through its Divisional Manager.

2.United India Insurance Co.Ltd. Regd. Head office 24, Whites Road, Chennai through its Managing Director.

                                                                  …..Opposite Parties.

 

                                      Complaint u/s 12 of the Consumer

                                      Protection Act.

 

Before          Sh.Subhash Goyal……..President.

                   Smt.Shashi Sharma……Member.

 

 

 

Present:-      Sh.Vishal Goel Advocate for the complainant.

                   Sh.Sudhakar Mittal Advocate for the Ops.

ORDER

 

                   The complainant has filed the present complaint against the Ops u/s 12 of the Consumer Protection Act on the grounds that the complainant has obtained Individual Health Insurance policy from the Ops vide policy bearing No. 110700/48/12/97/00000137   dated 21.08.2012 valid w.e.f. 4.9.2012 to 3.9.2013. It was also alleged that the complainant, his wife Smt.Nisha Gupta and his children were covered under the said policy. That some problem occurred in the stomach of the complainant and he was admitted in Parveen Hospital, Karnal on 7.10.2012 and was diagnosed of Right  renal Colic with Right Ureteric Stone and was operated  and remained their admitted from 7.10.2012 to 10.10.2012 and the complainant spent Rs.47,114/- for his treatment. The Ops were informed regarding his treatment. Thereafter, the complainant lodged the claim with the Ops and submitted all the relevant documents  with the Ops but the claim of the complainant has not been paid which amounts to deficiency in services on the part of the Ops.. Thus, alleging deficiency in services on the part of the Ops, the complainant has  filed the present complaint against the Ops and have sought the  payment of the claim amount and compensation for the harassment caused to them and also litigation expenses.  Complainant Rajiv Gupta has also tendered his affidavit in support of the contents of the complaint alongwith certain other documents which will be discussed at the relevant places.

 

2.                On notice the Ops  appeared and filed joint written statement raising the  that the complaint was bad for mis joinder and non joinder of the necessary parties; that the complainant has no cause of action to file the present complaint and that the complainant was estopped by his own act and conduct from filing the present complaint.

 

                   On merits issuance of the insurance policy has not been denied by the Ops. It has been contended that the complainant neither lodged any claim with the Ops nor submitted any documents with the Ops, therefore, the question of deciding the claim of the complainant  does not arises at all. The other averments made in the complaint have been denied by the Ops in their written statement. Sh.S.S.Vasudeva Depty, Manager of the Ops  has also tendered his affidavit in support of the contentions made in the written statement.

 

3.                We have heard the learned counsel for the parties and have gone through the case file very carefully.

 

4.                After going through the evidence on the file and circumstances of the present case and hearing the arguments advanced by the learned counsel for the parties, it emerges that the complainant has not produced any evidence on the file to show that the complainant ever informed the Ops regarding his treatment  or lodged claim with the OPs regarding the expenses incurred by him on his treatment.  In such circumstances, it has to be held that in the absence of lodging of any claim no deficiency can be said to have taken place on the part of the OPs and as such no cause of action can be said to have accrued in favour of the complainant and thus the present complaint is pre-mature.

 

5.                Therefore, in view of the above discussion, we direct the complainant to lodge the claim with the OPs within a period of fifteen days and thereafter the OPs shall settle the claim of the complainant within a period of thirty days.   The present complaint is disposed off accordingly. The parties concerned be communicated of the order accordingly and file be consigned to the record room after due compliance.

 

Announced

Dated 17.03.2015                                                  (Subhash Goyal)

                                                                                President,

District Consumer Disputes  

Redressal Forum, Karnal.

 

                   (Smt.Shashi Sharma)

                             Member

 

 

 

 

 

Present:-      Sh.Vishal Goel Advocate for the complainant.

                   Sh.Sudhakar Mittal Advocate for the Ops.

                  

                   Arguments heard. Vide our separate order of the even date, the present complaint has been disposed off.  The parties concerned be communicated of the order accordingly and file be consigned to the record room after due compliance.

 

 

Announced

Dated 17.3.2015                                                    (Subhash Goyal)

                                                                                President,

District Consumer Disputes  

Redressal Forum, Karnal.

 

                   (Smt.Shashi Sharma)

                             Member